Annex 1a: Certificate of Insurance or other financial security in respect of Shipowners’ liability as required under regulation 4.2 standard A4.2.1 paragraph 1(b) of the Maritime Labour Convention 2006 (MLC) as amended

CERTIFICATE OF INSURANCE OR OTHER FINANCIALSECURITY IN RESPECT OF SHIPOWNERS’ LIABILITY AS REQUIRED UNDER REGULATION 4.2 STANDARD A4.2.1 PARAGRAPH 1 (b) OF THE MARITIME LABOUR CONVENTION 2006 AS AMENDED

Name of the shipowner on whose behalf financial security has been provided:

Period of validity of the financial security:

THIS IS TO CERTIFY that there is in force a policy of insurance or other financial security in respect of the above-named ship while in the above ownership which meets the financial security requirements of Standard A4.2.1 paragraph 1(b) of the Maritime Labour Convention 2006 as Amended, where it is in force and applicable

Provided always that the insurer or provider of financial security may cancel this Certificate in accordance with Standard A4.2.1.12 by giving at least 30 days’ written notice to the competent authority of the flag State whereupon the liability of the insurer hereunder shall cease as from the date of expiry of the said period of notice but only as regards events arising thereafter.

The policy of insurance is subject to certain conditions and limitations details of which can be found on the provider’s website under “Maritime Labour Convention Certificates Clause – Interim”.

This certificate has been issued for and on behalf of the above-named provider of insurance or other financial security.

Date:

By:

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